Intervertebral Differential Dynamics Therapy
Original Editor - Ezinne Chika Ekediegwu
Top Contributors - Naomi O'Reilly and Tarina van der Stockt
Introduction[edit | edit source]
Many treatment approaches for spine-related musculoskeletal conditions (neck or low back pain) have evolved in healthcare. This has corresponded with the rapid increase in the burden of back-related disabilities . Among the numerous approaches available for managing these conditions, pharmacology, surgery and physiotherapy have remained the most popular practices in the world  . At first, the best and only acceptable means of addressing such conditions in patients is by administering a wide range of opioids and steroids . Surgery becomes the next line of treatment in more severe cases, irrespective of its obvious complication and economic cost. On this note, adjunct treatments and physiotherapy became the limelight in managing spine-related musculoskeletal conditions. Opioids and surgeries may still be effective; nevertheless, the advent of non-surgical spinal decompression such as Intervertebral Differential Dynamics (IDD) has provided a safer and cost-effective breakthrough for patients presenting with spinal-related conditions  . The main reasons for IDD therapy advocacy are;
- chronic neck and back pain are the major causes of disability,
- there is an ongoing opioid pain medication epidemic in the United States, and other countries of the world,
- the majority of patients prefer to avoid the risks of surgery or suffer from spine-related musculoskeletal conditions contraindicated to surgical intervention,
- IDD is cheaper and safer when compared with surgical procedures and
- the computerised system of IDD seems to produce consistent, reproducible, and measurable non-surgical decompression, demonstrated by radiology 
Definition[edit | edit source]
Simply put, Intervertebral Differential Dynamics (IDD) means decompression of intervertebral segments, aimed at varying spinal levels with dynamic distraction and longitudinal mobilisation. It is a precise and powered advanced form of spinal decompression treatment used to open the disc space between targeted vertebrae to alleviate pain caused by disc compression and degeneration  . Intervertebral Decompression Dynamics therapy (IDDT) is the latest incarnation of non-surgical spinal decompression therapy which involves spinal stretching on an IDD therapy device aimed at relieving neck or back pain . It is a non-invasive spinal rehabilitation treatment developed by Norman Shealy, designed by a group of medical practitioners (consisting of neurosurgeons, physiotherapists, orthopaedic surgeons and other healthcare practitioners) and is delivered by the Accu-SPINA® spinal care device in an attempt to improve the efficacy of spinal pain management . The Food and Drug Administration has approved and cleared the Accu-SPINA® spinal care as a class II medical device. Individuals with neck or back pain who have deferred other treatment options for at least three (3) months are usually the best candidates for this kind of therapy . It has remained the most significant advancement in treating neck or back deformities associated with persistent pain.
IDD therapy consists of a set of computer-directed physiotherapeutic treatment regiments to heal or rehabilitate damaged structures in the cervical and lumbar intervertebral discs as well as facet joints, with a course of treatment consisting of 20 sessions of 25 to 30 minutes, spread over six weeks . The IDD device (figure 1) offers computer-directed static, intermittent, and cycling forces delivered accurately to distract the targeted injured spinal segments gently, thereby creating a negative intra-discal pressure to promote retraction or re-positioning of the bulging or herniated disc material and lower pressure in the intervertebral disc for the influx of healing nutrients into the disc using decompressive forces . The creation of negative intra-discal pressure is the main distinguishing factor between IDD therapy and traditional traction therapy.
With this, pressure is taken off from specific injured intervertebral discs and nerves whilst at the same time, tight muscles and stiff ligaments are gently stretched with a resultant reduction in disc herniation size and improvement in pain, depression, straight leg raise (SLR) and disability . The spinal decompression technique with IDD therapy consists of high- and low-tension forces, with the low-tension force remaining above zero to maintain controlled tension during therapy (Figure 2). The sinusoidal waveform of the therapy details the fact that the decompressive force is a non-linear pull applied slowly to the Golgi tendon organ, allowing it to fire yet inhibiting increased tension in the muscle. This, therefore, allows the muscles to remain relaxed whilst being lengthened . It is noteworthy that the patented oscillation capability that IDD therapy offers is usually at the “point of maximum joint distraction” . In addition, clinicians can correctly and adequately review and modify every single treatment on the IDD therapy device because every aspect of the therapy is recorded and adjustable with measurable outcomes. Traditional traction is, however, limited in offering these aforementioned benefits.
Specific Features[edit | edit source]
- Computerised and individualised program based on the patient’s pathology
- Mobilise and manipulate distinct spinal segments to induce negative intra-discal pressure
- Designed to provide static, intermittent and cyclic oscillation forces
- Forces are applied to a distinct disc in variable direction, frequency and amplitude 
Therapeutic Effects[edit | edit source]
- Comfortably re-educate (stretch and work) supporting soft tissues to increase joint range of motion
- Distract and mobilise the facet joints
- Open the disc space to create pressure differentials for fluid exchange (promoting diffusion of oxygen, water and nutrients into the vertebral disc area for rehydration of degenerated disc, stimulation of metabolism and promotion of disc healing)
- Create negative pressure to promote retraction of disc bulge and remove pressure on nerves
- Re-align spinal structures and rehabilitate damaged discs
- Release endorphins for pain relief and stress reduction, thereby making the therapy session so comfortable and sedative
- Deliver passive exercise elements to reduce muscle spasm
- Provide an environment for the body to heal itself. 
Indications[edit | edit source]
- Herniated or bulging discs
- Degenerative disc disease
- Facet syndrome
- Cervical radiculopathy
- Chronic low back and neck pain
(Per the IDD device manufacturer’s protocol/recommendation)
Contraindications[edit | edit source]
- Cauda Equina Syndrome
- Spondylolithesis (Grade II or higher)
- Osteoporosis (T-score greater than -2.5)
- Spinal surgery (less than six months)
- Surgical hardware in the spine
- Vertebral fracture(s) (less than six months)
- Patients less than 18 years
- Postpartum (less than six months)
- Congenital spinal abnormalities
- Rotatory or severe scoliosis
(Per the IDD device manufacturer’s protocol/recommendation)
Treatment Protocol[edit | edit source]
IDD therapy comprises varying treatment sessions designed for each patient, lasting 25 to 30 minutes . Its protocols allow the controlled distraction of targeted vertebrae to mobilise the joint and create negative pressure inside the intervertebral disc. A session of IDD therapy is usually preceded by targeted exercises or manual therapy or 10 minutes of FAR infrared on the affected segment (neck or back) to increase blood circulation. After the session, 10 minutes of cold therapy to reduce soreness is usually recommended. For optimal benefit, the manufacturer of the IDD device recommends 20 sessions of IDD therapy 3 to 5 times a week for 6 to 8 weeks for patients with neck or back pain.
Outcome Measures[edit | edit source]
Clinicians can monitor treatment progress using the IDD device's inbuilt Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) outcome measures
Previous Studies on IDD Therapy[edit | edit source]
Documented findings about the therapeutic goals achieved through the IDD device exist. Shealy  reported an average of 65% and 76% pain reduction in Americans with low back pain after IDD therapy and one-year post-IDD therapy, respectively. McClure & Farris  examined 415 patients treated with IDD therapy programmes, with treatment success measured as a 50%+ decrease in average pain scores taken at 2 months and 2 years. A double-blinded randomised controlled trial by Demirel et al.  answered one of the most rampant questions about IDD, in this light, whether non-surgical spinal decompression therapy makes a difference in managing spinal dysfunction. Demirel et al. reported a significant decrease in pain level, functional restoration and reduction in the thickness of the herniation among the study group (those that standard care and IDD therapy) versus the control group (those that received standard care only). Standard care was defined as receiving electrotherapy, stabilisation exercise, and frictional massage.
Schaufele and Newsome  concluded in their study on patients with symptomatic lumbar degenerative disc disease that IDD therapy, compared with exercise-based physiotherapy, offers similar clinical improvement. The first study on IDD therapy carried out by Ekediegwu and colleagues  in Africa revealed that in conjunction with physiotherapeutic modalities, IDD therapy offers statistically significant reduction in low back pain as measured on VAS. In addition, the efficacy of IDD therapy in conjunction with conventional conservative treatment has been further proven and highly recommended .
References[edit | edit source]
- ↑ Buchbinder, R., Van Tulder, M., Öberg, B., Costa, L. M., Woolf, A., Schoene, M., Croft, P., Buchbinder, R., Hartvigsen, J., Cherkin, D., Foster, N. E., Maher, C. G., Underwood, M., Van Tulder, M., Anema, J. R., Chou, R., Cohen, S. P., Menezes Costa, L., Croft, P., … Woolf, A. (2018). Low back pain: A call for action. The Lancet, 391(10137), 2384-2388. https://doi.org/10.1016/s0140-6736(18)30488-4
- ↑ Meroni, R., Piscitelli, D., Ravasio, C., Vanti, C., Bertozzi, L., De Vito, G., Perin, C., Guccione, A. A., Cerri, C. G., & Pillastrini, P. (2019). Evidence for managing chronic low back pain in primary care: A review of recommendations from high-quality clinical practice guidelines. Disability and Rehabilitation, 43(7), 1029-1043. https://doi.org/10.1080/09638288.2019.1645888
- ↑ Pillastrini, P., Gardenghi, I., Bonetti, F., Capra, F., Guccione, A., Mugnai, R., & Violante, F. S. (2012). An updated overview of clinical guidelines for chronic low back pain management in primary care. Joint Bone Spine, 79(2), 176-185. https://doi.org/10.1016/j.jbspin.2011.03.019
- ↑ Curatolo, M., & Bogduk, N. (2001). Pharmacologic pain treatment of musculoskeletal disorders: Current perspectives and future prospects. The Clinical Journal of Pain, 17(1), 25-32. https://doi.org/10.1097/00002508-200103000-00005
- ↑ Smith, J. S., Klineberg, E., Lafage, V., Shaffrey, C. I., Schwab, F., Lafage, R., Hostin, R., Mundis, G. M., Errico, T. J., Kim, H. J., Protopsaltis, T. S., Hamilton, D. K., Scheer, J. K., Soroceanu, A., Kelly, M. P., Line, B., Gupta, M., Deviren, V., Hart, R., … _, _. (2016). Prospective multicenter assessment of perioperative and minimum 2-year postoperative complication rates associated with adult spinal deformity surgery. Journal of Neurosurgery: Spine, 25(1), 1-14. https://doi.org/10.3171/2015.11.spine151036
- ↑ Romero-Morales, C., Bravo-Aguilar, M., Abuín-Porras, V., Almazán-Polo, J., Calvo-Lobo, C., Martínez-Jiménez, E. M., López-López, D., & Navarro-Flores, E. (2021). Current advances and novel research on minimal invasive techniques for musculoskeletal disorders. Disease-a-Month, 67(10), 101210. https://doi.org/10.1016/j.disamonth.2021.101210
- ↑ Manchikanti, L., Singh, V., Kaye, A. D., & Hirsch, J. A. (2020). Lessons for better pain management in the future: Learning from the past. Pain and Therapy, 9(2), 373-391. https://doi.org/10.1007/s40122-020-00170-8
- ↑ Jadon, D. A. (2017). Non-operative management of Discogenic back pain by Intradiscal interventions: An evidence based review. SDRP Journal of Anesthesia & Surgery, 1(1). https://doi.org/10.25177/jas.1.1.2
- ↑ 9.0 9.1 Schimmel, J. J., De Kleuver, M., Horsting, P. P., Spruit, M., Jacobs, W. C., & Van Limbeek, J. (2009). No effect of traction in patients with low back pain: A single centre, single blind, randomized controlled trial of Intervertebral differential dynamics therapy®. European Spine Journal, 18(12), 1843-1850. https://doi.org/10.1007/s00586-009-1044-3
- ↑ Gay, R. E., & Brault, J. S. (2008). Evidence-informed management of chronic low back pain with traction therapy. The Spine Journal, 8(1), 234-242. https://doi.org/10.1016/j.spinee.2007.10.025
- ↑ Van Tulder, M. W., Koes, B. W., & Bouter, L. M. (1997). Conservative treatment of acute and chronic Nonspecific low back pain. Spine, 22(18), 2128-2156. https://doi.org/10.1097/00007632-199709150-00012
- ↑ 12.0 12.1 12.2 12.3 12.4 Henry, L. (2017). Non-surgical spinal decompression an effective physiotherapy modality for neck and back pain. Journal of Novel Physiotherapy and Physical Rehabilitation, 4(3), 062-065. https://doi.org/10.17352/2455-5487.000049
- ↑ Shealy, C. N., & Borgmeyer, V. (2003). Decompression, reduction, and stabilization of the lumbar spine: a cost-effective treatment for lumbosacral pain. Technology Review, 6(5).
- ↑ 14.0 14.1 Choi, J., Lee, S., & Hwangbo, G. (2015). Influences of spinal decompression therapy and general traction therapy on the pain, disability, and straight leg raising of patients with intervertebral disc herniation. Journal of Physical Therapy Science, 27(2), 481-483. https://doi.org/10.1589/jpts.27.481
- ↑ Ramos, G., & Martin, W. (1994). Effects of vertebral axial decompression on intradiscal pressure. Journal of Neurosurgery, 81(3), 350-353. https://doi.org/10.3171/jns.1994.81.3.0350
- ↑ 16.0 16.1 16.2 16.3 16.4 16.5 Patnaik, G. (2018) Role of IDD therapy in the back and neck pain. Journal of Medical Student Research 1:002
- ↑ 17.0 17.1 17.2 Gay R (2013) All About Spinal Decompression Therapy. SPINE-health. Available from: https://www.spine-health.com/treatment/chiropractic/all-about-spinal-decompression-therapy (accessed 1 Sep 2022).
- ↑ 18.0 18.1 18.2 18.3 18.4 18.5 McClure, D. & Farris, B. (2006). Intervertebral Differential Dynamics Therapy – A New Direction for the Initial Treatment of Low Back Pain. European Musculoskeletal Review. 45-48.
- ↑ Awad, J. N., & Moskovich, R. (2006). Lumbar disc Herniations. Clinical Orthopaedics & Related Research, 443, 183-197. https://doi.org/10.1097/01.blo.0000198724.54891.3a
- ↑ Andersson, G. B., Schultz, A. B., & Nachemson, A. L. (1983). Intervertebral disc pressures during traction. Scandinavian journal of rehabilitation medicine. Supplement, 9(2), 88-91.
- ↑ Shealy, C. N. (2005). Long-term effect analysis of IDD therapy in low back pian: a retrospective clinical pilot study. American Journal of Pain Management, 15, 93-97.
- ↑ Shealy, C. N. (2005). Intervertebral differential dynamics therapy. Practical Pain Management, 5(3), 64-65.
- ↑ 23.0 23.1 Demirel, A., Yorubulut, M., & Ergun, N. (2017). Regression of lumbar disc herniation by physiotherapy. Does non-surgical spinal decompression therapy make a difference? double-blind randomized controlled trial. Journal of Back and Musculoskeletal Rehabilitation, 30(5), 1015-1022. https://doi.org/10.3233/bmr-169581
- ↑ Schaufele, M. K., & Newsome, M. (2011). Intervertebral Differential Dynamics (IDD) Therapy vs. Exercise Based Physical Therapy–Results from a Randomized Controlled Trial. Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin, 21(01), 34-40.
- ↑ Ekediegwu, E., Chuka, C., Nwosu, I., Ogbueche, C., Ekechukwu, E., Uchenwoke, C., & Odole, A. (2021). Reduction in Chronic Low Back Pain Using Intervertebral Differential Dynamics Therapy (IDDT) and Routine Physiotherapy: A Retrospective Pre-Post Study. Journal of Musculoskeletal Disorders and Treatment, 7(2) :098
- ↑ Kang, J.I., Jeong, D.K., Choi, H. (2016). Effect of spinal decompression on the lumbar muscle activity and disk height in patients with herniated intervertebral disk. Journal of Physical Therapy Science 28: 3125-3130.
- ↑ Henry, L. (2015). Non-surgical spinal decompression of lumbar disc herniation: a case report and proposed multimodal chiropractic treatment approach. The Internet Journal of Chiropractic. 4:1
- ↑ Macario, A., Richmond, C., Auster, M., Pergolizzi, J.V. (2008). Treatment of 94 outpatients with chronic discogenic low back pain with the DRX9000: a retrospective chart review. Pain Practical. 8(1):11-17. Doi: 10.1111/j.1533-2500.2007.00167.x. PMID: 18211590.